What are the first-line treatment options for managing eosinophilic oesophagitis in children and adults?

First-line treatment options for managing eosinophilic oesophagitis (EoE) in children and adults include dietary management and pharmacological therapy.

Dietary approaches often involve elimination diets to remove potential food triggers, such as cow's milk, wheat, soy, eggs, nuts, and seafood, which are common allergens implicated in EoE. In children, a trial of cow's milk elimination may be considered initially, especially given the overlap of symptoms with cow's milk allergy, which can mimic gastro-oesophageal reflux disease (GORD) symptoms NICE CKS.

Pharmacological treatment primarily involves topical corticosteroids, such as swallowed fluticasone or budesonide, which reduce eosinophilic inflammation in the oesophagus. These are considered first-line medical therapies for both children and adults with confirmed EoE, aiming to induce histological remission and symptom control Chen 2020Elghoudi et al. 2024Savarino et al. 2024.

Proton pump inhibitors (PPIs) may also be used as initial therapy, as they can reduce oesophageal eosinophilia in some patients, possibly due to their anti-inflammatory effects beyond acid suppression. PPIs are often trialed to distinguish PPI-responsive oesophageal eosinophilia from EoE, and they remain a first-line option in both children and adults Chen 2020Savarino et al. 2024.

In summary, the first-line management of EoE involves a combination of dietary elimination strategies and topical corticosteroids, with PPIs used as an initial or adjunctive therapy. Specialist referral for endoscopic assessment with biopsies is essential to confirm diagnosis and guide treatment. This integrated approach aligns with current UK clinical practice and evolving international evidence (Chen, 2020; Elghoudi et al., 2024; Savarino et al., 2024; NICE CKS).